Sickle cell anaemia: preoperative aggressive transfusion was not clearly better than conservative transfusion.

Clinical bottom line (level 1b-)

  1. Patients with sickle cell anaemia who were undergoing elective cholecystectomy and were given aggressive transfusion preoperatively, had no clear difference in perioperative complications than those given conservative transfusion.
Haberkern et al: Blood 1997; 89 (5): 1533-1542
Expires June 2003

The study

Unblinded concealed randomised trial without intention-to-treat
Setting: 36 centres, USA

230 patients (aged mean 16 years, 57% male) sickle cell disease, haemoglobin SS or S ß ° , and undergoing elective surgery (surgery occurring 24 hours or longer after registration)

Excluded if
  • recent blood transfusion


    • Control Group: (n = 120, 120 analysed): conservative transfusion before cholecystectomy, to obtain a haemoglobin of 10 g/dl, independent of haemoglobin S percent
    Experimental Group: (n = 110, 110 analysed): aggressive transfusion after cholecystectomy, to obtain a preoperative haemoglobin of 10 g/dl and haemoglobin S percent of 30 or less

    100% followed for 30 days
    Outcome notes:
    • perioperative complications : intraoperative/recovery room, acute chest, pain, fever, surgical postoperative, miscellaneous postoperative, renal, neuro, death, transfusion-related complications

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    perioperative complications 30 days 39
    (32.5%)    		 36
    (32.7%)    		 -1%
    (-46% to 31%)    		 -0.23%
    (-12.4% to 11.9%)    		 -440
    (NNT = 8 to infinity;
    NNH = 8 to infinity)

    Comments

    1. The study is too small to show any clear difference between the two transfusion regimens.

    Citation

    1. Haberkern CM, Neumayr LD, Orringer EP, et al: Cholecystectomy in sickle cell anemia patients: perioperative outcome of 364 cases from the NationalPerioperative Transfusion Study. Blood 1997; 89 (5): 1533-1542
    Contributor: Clare Wotton and Musab Hayatli, June 2000
    Reviewer:

    Clinical Question.
    Patient sickle cell anaemia anemia
    Intervention or Exposure aggressive transfusion preoperatively
    Comparison conservative transfusion preoperatively
    Outcome sickle cell events